The trauma of high costs

ON THE same day that Moody's rating agency declared that runaway medical costs are making the Massachusetts universal health plan unsustainable, Tufts Medical Center in Boston announced a plan to become a state-designated trauma center. The money needed for this upgrade would add to the costs that patients and employers must bear when they use Tufts services. If Boston were lacking in trauma centers, the investment would make sense, but the city already has four: Boston Medical Center, Brigham and Women's, Beth Israel Deaconess, and Massachusetts General. It needs another trauma center like it needs another sports bar.

Trauma centers treat the victims of gunshots, stabbings, car collisions, and falls. They must have the staff and facilities to do, at short notice, complex surgeries, including neurosurgery, with access to quick imaging and laboratory results. Once a hospital's trauma facilities win the approval of the American College of Surgeons, the hospital can apply for designation by the state Department of Public Health. With designation by the state, a center is more likely to get trauma victims brought by ambulances.

Unfortunately, under current rules, trauma centers are not subject to the state's "determination of need" process, so the state cannot reject the application on the grounds that Boston already has more than enough trauma capacity. The state should change the rules to include oversight of the centers.

If Tufts were in Western Massachusetts, where trauma centers are few and far apart, its proposal might make sense. But in Boston, no one needing trauma care lives more than a few miles from a center.

Tufts Medical Center's chief executive, Ellen Zane, argues that while the Longwood medical area has two adult and one pediatric trauma center, even though it has relatively few residents, the Chinatown neighborhood of her center is densely populated and has none. But traumatic injuries don't always occur near home, and most state residents would be happy to be as close to quality trauma centers as Chinatown is. Zane also argues that because Tufts already has a pediatric trauma center, creating an adult one will require little additional expense.

Massachusetts is trying to achieve universal healthcare despite having the highest per-capita health expenditures in the nation. The state's outstanding teaching hospitals, including Tufts Medical Center, are one factor raising health costs here. The gloomy prediction from Moody's that universal care is unaffordable could prove true if all involved in healthcare do not strive to keep outlays down. Four trauma centers in Boston are plenty.